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  • Long-term cognitive impairment and delirium in intensive care (LOGIC): A prospective cohort study

    Author(s)
    Mitchell, Marion
    Aitken, Leanne
    Shum, David
    Mihala, Gabor
    Murfield, Jenny
    Griffith University Author(s)
    Mihala, Gabor
    Shum, David
    Mitchell, Marion L.
    Aitken, Leanne M.
    Murfield, Jenny E.
    Year published
    2016
    Metadata
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    Abstract
    Delirium is a neurocognitive disorder affecting intensive care patients and is linked to poorer clinical patient outcomes including prolonged mechanical ventilation; increased intensive care unit (ICU) and hospital length of stay. This study was designed to determine the incidence and associations between delirium in ICU and patients’ cognition at 3 and 6 months post-hospital discharge. A prospective cohort study was undertaken within a 25-bed ICU. Adult medical and surgical ICU patients who received >12 hour mechanical ventilation were assessed daily for delirium using the Confusion Assessment Method (CAM-ICU). Cognitive ...
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    Delirium is a neurocognitive disorder affecting intensive care patients and is linked to poorer clinical patient outcomes including prolonged mechanical ventilation; increased intensive care unit (ICU) and hospital length of stay. This study was designed to determine the incidence and associations between delirium in ICU and patients’ cognition at 3 and 6 months post-hospital discharge. A prospective cohort study was undertaken within a 25-bed ICU. Adult medical and surgical ICU patients who received >12 hour mechanical ventilation were assessed daily for delirium using the Confusion Assessment Method (CAM-ICU). Cognitive testing was conducted 3 and/or 6 months post-hospital discharge using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Mini Mental State Examination (MMSE), and the timed Trail Making Tests A and B (TMT). Descriptive data are presented as frequencies and median [inter-quartile range]. Factors associated with cognitive impairment were identified through multivariate regression. Participants (n = 148) were recruited and 91 (60%) completed either one or two follow-up assessments. Participants were 57 years old [43–65], received 2.2 days of mechanical ventilation [1–5.1] and remained in ICU for 4.3 days [2.1–7.9]. Delirium occurred in 14 participants (19%), although only 5 (7%) experienced delirium on multiple days. Numbers (%) of patients who were cognitively impaired on RBANS and MMSE respectively were: 3 months – 27 (36%), 2 (2.3%); 6 months – 17(22%), 4(5.1%). TMT A (seconds) was 32.5 [23.5–45.5] at 3 months and 30.5 [24.6–40.5)] at 6 months. TMT B (seconds) was 91.8 [59.5–114] at 3 and 77.4 [56.5–119] at 6 months. Delirium was associated with cognitive impairment at 6 months for the TMT A (Point Estimate = 7.86[0.7–17.9], p = 0.03) and the TMT B (Point Estimate = 24 [0.9–59.5], p = 0.04) assessments. Delirium was identified in a minority of patients but was associated with long-term cognitive impairment. Strategies to improve ICU care that reduce long-term cognitive deficits are imperative. Acknowledgements: Funding for this project was received from: Princess Alexandra Hospital Foundation; Australian College of Critical Care Nurses; Griffith Health Institute.
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    Conference Title
    Australian Critical Care
    Volume
    29
    Issue
    2
    DOI
    https://doi.org/10.1016/j.aucc.2015.12.027
    Subject
    Clinical sciences
    Nursing
    Science & Technology
    Life Sciences & Biomedicine
    Critical Care Medicine
    General & Internal Medicine
    Publication URI
    http://hdl.handle.net/10072/404340
    Collection
    • Conference outputs

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